Patterns of Trust in Financial Services: Critical Factors and Gender Differences

This study investigates the interrelationships among factors of trust in financial services. Additionally, it examines how these factors correlate with gender differences, offering insights into trust patterns in emerging markets. Ethiopia, characterised by economic and financial volatility, was selected as a case study for an emerging market. A sample of 470 individuals was surveyed with the assistance of interviewers to overcome language and literacy obstacles, with balanced representation across key demographics, particularly gender, enabling robust statistical analysis. Logistic regression and correlation matrices were employed to analyse trust. The study reveals that correlations between trust factors vary widely but are predominantly positive, with only one exception. Gender differences in trust factors are evident but do not represent significant schisms in financial behaviour. Unexpectedly, digital trust exhibits a strong positive correlation with age, challenging assumptions about generational preferences for financial technologies. While the sample size aligns with standard practices in similar studies, expanding the dataset would improve the precision of the analysis. The complexity of administering detailed surveys at scale poses a challenge for single studies. This study demonstrates the utility of combining traditional determinants of trust with advanced statistical methods, such as logistic regression, to uncover probabilities and interactions among trust factors. Gender differences in trust patterns exist but are less pronounced than expected, even in a society with significant gender disparity. Other demographic factors, such as age, education, and income, play more substantial roles in shaping trust behaviours, suggesting that financial inclusion efforts should prioritise these variables. This research highlights the transformative potential of digital trust, which extends beyond traditional definitions of trust. Despite operating in a society with high gender disparity, the findings indicate that gender is not a significant concern in financial trust patterns

Patient Self-Harm in the Emergency Department: An Evidence- Based Approach

Violence, deliberate self harm, and suicide in emergency departments and hospitals is likely to remain a significant problem for health care systems well into the future. Understanding how to confront, intervene, and manage episodes of patient deliberate self harm is extremely important, and can be life-saving. Here, through a clinical vignette, and a discussion of deliberate self harm we will highlight the importance of the direct observation of such patients, containment procedures (seclusion and physical restraints), and the use of pharmacological adjuncts. We hope that this concise, practically-oriented review will provide our readers with foundational understanding of the topic, including the most important theoretical and clinical considerations

Myeloid Cells in the Immunosuppressive Microenvironment as Immunotargets in Osteosarcoma

Osteosarcoma is an aggressive primary malignant bone tumor associated with high rates of metastasis and poor 5-year survival rates with limited improvements in approximately 40 years. Standard multimodality treatment includes chemotherapy and surgery, and survival rates have remained stagnant. Overall, response rates to immunotherapy like immune checkpoint inhibitors have been disappointing in osteosarcoma despite exciting results in other epithelial tumor types. The poor response of osteosarcoma to current immunotherapies is multifactorial, but a key observation is that the tumor microenvironment in osteosarcoma is profoundly immunosuppressive, and increasing evidence suggests a significant role of suppressive myeloid cells in tumor progression and immune evasion, particularly by myeloid-derived suppressor cells. Targeting suppressive myeloid cells via novel agents are attractive strategies to develop novel immunotherapies for osteosarcoma, and combination strategies will likely be important for durable responses. In this review, we will examine mechanisms of the immunosuppressive microenvironment, highlight pre-clinical and clinical data of combination strategies including colony-stimulating factor 1 (CSF-1) receptor, phosphoinositide 3-kinase (PI3K), CXCR4, and checkpoint inhibition, as well as the role of canine models in elucidating myeloid cells as targets in osteosarcoma immunotherapy

Myeloid Cells in the Immunosuppressive Microenvironment as Immunotargets in Osteosarcoma

Cyrus J Sholevar,1 Natalie M Liu,1 Tasneem Mukarrama,2 Jinhwan Kim,2 Jessica Lawrence,3 Robert J Canter1 1Department of Surgery, Division of Surgical Oncology, University of California Davis, Sacramento, CA, USA; 2Biomedical Engineering, University of California Davis, Sacramento, CA, USA; 3Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USACorrespondence: Robert J Canter, Research Building III, University of California Davis, 4645 Second Ave Room 2200D, Sacramento, CA, 95817, USA, Email [email protected]: Osteosarcoma is an aggressive primary malignant bone tumor associated with high rates of metastasis and poor 5-year survival rates with limited improvements in approximately 40 years. Standard multimodality treatment includes chemotherapy and surgery, and survival rates have remained stagnant. Overall, response rates to immunotherapy like immune checkpoint inhibitors have been disappointing in osteosarcoma despite exciting results in other epithelial tumor types. The poor response of osteosarcoma to current immunotherapies is multifactorial, but a key observation is that the tumor microenvironment in osteosarcoma is profoundly immunosuppressive, and increasing evidence suggests a significant role of suppressive myeloid cells in tumor progression and immune evasion, particularly by myeloid-derived suppressor cells. Targeting suppressive myeloid cells via novel agents are attractive strategies to develop novel immunotherapies for osteosarcoma, and combination strategies will likely be important for durable responses. In this review, we will examine mechanisms of the immunosuppressive microenvironment, highlight pre-clinical and clinical data of combination strategies including colony-stimulating factor 1 (CSF-1) receptor, phosphoinositide 3-kinase (PI3K), CXCR4, and checkpoint inhibition, as well as the role of canine models in elucidating myeloid cells as targets in osteosarcoma immunotherapy.Keywords: MDSC, macrophage, immunotherapy, sarcoma, tumor microenvironmen

Sensing and detection performance of the novel, small-diameter OmniaSecure defibrillation lead: in-depth analysis from the LEADR trial

Aims The Lead EvaluAtion for Defibrillation and Reliability (LEADR) trial evaluated the small-diameter (4.7 Fr), integrated bipolar OmniaSecure defibrillation lead. As previously reported, the trial exceeded primary safety and efficacy objective thresholds, demonstrating favourable performance and zero fractures through similar to 12 months follow-up, with patients in ongoing follow-up. Longer-term follow-up of the LEADR trial with emphasis on the sensing and detection capabilities of the OmniaSecure lead is reported here.Methods and results Patients with indications for de novo implantable cardioverter-defibrillators/cardiac resynchronisation therapy defibrillators were implanted with the OmniaSecure lead in standard right ventricle (RV) locations and followed at pre-specified intervals along with CareLink (TM) remote monitoring transmissions, where available. Throughout follow-up, the lead was evaluated for safety, efficacy, and reliability along with sensing and detection performance. There were 643/657 (97.9%) patients successfully implanted with the OmniaSecure lead with mean follow-up of 18.2 +/- 5.5 months. There was a 96.9% freedom from major study lead-related complications at 24 months. Inappropriate shock rate was 2.7 and 3.8% at 12 and 24 months, respectively. At 24 months, 17.6% of patients received appropriate therapies (shock and/or ATP) with a 76.5% ATP efficacy. There have been zero fractures during follow-up along with chronically stable pacing capture threshold, pacing impedance, and R-wave amplitudes. There were four patients with an adverse event related to PWOS (0.6%), none of which was associated with inappropriate shock. There were four patients with an adverse event related to TWOS (0.6%), of which three patients were associated with inappropriate shock (0.5%). Oversensing was resolved predominantly by programming the RV sensitivity to less sensitive settings. During VF induction at implant, 97.6% (120/123) of patients showed appropriate VF episode detection at the least sensitive setting of 1.2 mV, with the remaining having detection at more sensitive settings. In follow-up, 670 VT/VF episodes were appropriately detected and treated in 94 patients with a variety of RV sensitivities and no reports of under-detected episodes. Moreover, a virtual sensitivity analysis also showed no under-detection across different RV sensitivity programming.Conclusion Chronic sensing performance of the OmniaSecure defibrillation lead demonstrated R-wave stability with a low rate of P-wave and T-wave oversensing, resolved predominantly by adjusting RV sensitivity. Further, VT/VF detection was successful and was not impacted when programmed to less sensitive settings. The OmniaSecure lead shows robust sensing and detection performance and programmability in ongoing follow-up

Expanding the Whipple Accelerated Recovery Pathway (WARP) To All Patients Undergoing Pancreaticoduodenectomy (PD)

Introduction: Pancreaticoduodenectomy (PD) is a complex abdominal procedure with high rates of perioperative morbidity. The Whipple Accelerated Recovery Pathway (WARP) was developed for highly selected patients undergoing PD to reduce hospital length of stay (LOS) and time to adjuvant therapy (TTAT), without increasing post-operative complications (POC) or readmission rates (RR). The purpose of this study was to determine if WARP could be implemented for all-risk patients undergoing PD. Methods: A single-institution, retrospective analysis of 281 patients implemented on the WARP between 2017-2020 was performed. 119 patients were categorized as WARP-eligible (WEPs) according to original inclusion criteria, and 162 were deemed WARP-ineligible (WIPs). Primary endpoints include LOS, TTAT, RR, and POC. Data was collected from Epic and a multivariate analysis with logistic regression was performed. Results: 28 POC were found in WEPs (23.5%) compared to 73 POC in WIPs (45.1%) (p\u3c0.05). Delayed gastric emptying (DGE) and post-operative pancreatic fistulas (POPF) were higher in WIPs: DGE was found in 10.2% of WEPs vs. 26.2% of WIPs (p\u3c0.05), while POPF was found in 5.1% of WEPs vs. 21% of WIPs (p\u3c0.05). Mean LOS was 5 days for WEPs vs. 6 days for WIPs (p\u3c0.05). TTAT was 55 days for WEPs, compared to 63 days in WIPs (p\u3c0.05). RR was 12.6% for WEPs and 23.5% for WIPs (p\u3c0.05). Discussion: WARP results in lowered POC, TTAT, LOS, and RR, cutting costs to patients. WARP may be expanded to all PD patients; however, WIPs may benefit from additional modifications that are specific for patient risk factor

Comparative transcriptomic analysis of tumor- infiltrating canine natural killer cells and candidate biomarkers from first-in-dog NK immunotherapy trials

Natural killer (NK) cells have great potential to extend the promise of cancer immunotherapy, but additional research is needed to improve their efficacy in solid cancers. Dogs develop spontaneous cancers with striking similarities to humans and can serve as a crucial link to bridge murine studies and human clinical trials to improve treatment outcomes across species and identify potential biomarkers of response. Using single-cell RNA sequencing (scRNAseq), we integrated blood, tissue, and tumor samples from dog and human donors to compare NK cell gene expression and develop a canine sarcoma infiltrating NK signature. Canine tissue and tumor NK cell signatures were then used to contextualize NK cell changes in first-in-dog immunotherapy clinical trials. Tumor infiltrating NK cells from both canine and human sarcomas exhibited enhanced migration with a simultaneously exhausted signature that most closely correlated transcriptionally with NK cells isolated from the liver. We also analyzed peripheral blood NK cells from dogs on first-in-dog clinical trials undergoing three distinct NK-targeting immunotherapy regimens, observing that dogs with favorable responses demonstrated increased NK proportions posttreatment. Genes upregulated in NK cells in the peripheral blood of good responders included genes associated with activated NK cells and revealed post-treatment gene expression changes in the blood as a predictor of response. Overall, NK effector functions are well adapted to their tissue of residence but dysregulated in sarcoma infiltrating NK cells despite enhanced migration. We describe NK cell trends across canine clinical trials as a platform through which we can elucidate mechanisms of response and determine novel immunotherapy strategies to improve cancer outcomes in both humans and dogs

Conduct disorder in girls: neighborhoods, family characteristics, and parenting behaviors

<p>Abstract</p> <p>Background</p> <p>Little is known about the social context of girls with conduct disorder (CD), a question of increasing importance to clinicians and researchers. The purpose of this study was to examine the associations between three social context domains (neighborhood, family characteristics, and parenting behaviors) and CD in adolescent girls, additionally testing for race moderation effects. We predicted that disadvantaged neighborhoods, family characteristics such as parental marital status, and parenting behaviors such as negative discipline would characterize girls with CD. We also hypothesized that parenting behaviors would mediate the associations between neighborhood and family characteristics and CD.</p> <p>Methods</p> <p>We recruited 93 15–17 year-old girls from the community and used a structured psychiatric interview to assign participants to a CD group (n = 52) or a demographically matched group with no psychiatric disorder (n = 41). Each girl and parent also filled out questionnaires about neighborhood, family characteristics, and parenting behaviors.</p> <p>Results</p> <p>Neighborhood quality was not associated with CD in girls. Some family characteristics (parental antisociality) and parenting behaviors (levels of family activities and negative discipline) were characteristic of girls with CD, but notll. There was no moderation by race. Our hypothesis that the association between family characteristics and CD would be mediated by parenting behaviors was not supported.</p> <p>Conclusion</p> <p>This study expanded upon previous research by investigating multiple social context domains in girls with CD and by selecting a comparison group who were not different in age, social class, or race. When these factors are thus controlled, CD in adolescent girls is not significantly associated with neighborhood, but is associated with some family characteristics and some types of parental behaviors. However, the mechanisms underlying these relationships need to be further investigated. We discuss possible explanations for our findings and suggest directions for future research.</p